Mr. Z is a 63-year-old retired banker with a long history of chronic obstructive pulmonary disease (COPD). He is a longtime smoker, smoking four packs of cigarettes each day for 30 years

Mr. Z Scenario:

Mr. Z is a 63-year-old retired banker with a long history of chronic obstructive pulmonary disease (COPD). He is a longtime smoker, smoking four packs of cigarettes each day for 30 years. For the last week, Mr. Z has experienced a flulike illness with fever and chills. He also complains of nausea, exhaustion, anorexia, diarrhea, and a productive cough with thick, dark brownish yellow, purulent sputum.

Mr. Z is admitted to the telemetry unit with acute respiratory insufficiency. He is sitting up in a chair, leaning forward, with his elbows resting on the over-the-bed table. Mr. Z is breathing through his mouth, taking rapid shallow breaths, using his accessory muscles to ventilate. He appears anxious, angry, irritable and is barely having audible words between each breath. He is not very cooperative and is using profanity to express how he feels. Auscultation reveals crackles posteriorly over the lower right and left lung fields. When asked to inhale, his nostrils flare, and his intercostal muscles retract. On exhalation, he uses pursed-lip breathing, and his intercostal muscles bulge.

Mr. Z’s admission chest radiograph reveals infiltrates in bilateral lobes. Gram stain of Mr. Z’s sputum shows numerous gram-positive diplococci.

Ms. Y Scenario

https://lmscontent.embanet.com/Media/HPU/NUR6010/NUR6010-w06-m02/

Ms. Y Scenario:

Ms. Y is a 3-year-old with a history of asthma. She is brought in by her mother who indicates the child has not been eating well for the past few days. And today she looks restless and agitated. Both parents are present. Mother indicated child is allergic to peanuts and she found her eating cashew nuts.

Ms. Y is sitting up in her mother’s lap, taking rapid shallow breaths, using accessory muscles to ventilate and has a weak cry. Auscultation reveals expiratory wheezes. Father is calling out the child’s name repeatedly. Child has some dark bruises around her arms and looks frightened refusing to look at her father.

Include at least 2 scholarly external references from within the last five years in addition to your textbook(s).
Appropriately reference readings and other materials using APA 7th edition format. Whenever possible, post references as usable links.

Internal Sources:
Norris, T. L. (2020). Porth’s essentials of pathophysiology (5th ed.). Wolters Kluwer. ISBN-13: 978-1-975107-19-2